Philosplaat®

Gerelateerde onderwerpen

Specifiek:

humerusschachtfractuur | supracondylaire humerusfractuur | humeruskopfractuur | subcapitale humerusfractuur | tuberculum majus fractuur

OK-verslag:

humerusschachtfractuur (intramedullaire pen) |
proximale humerusfractuur (Philosplaat)

Algemeen:

ATLS

Anatomie:

schouder & armen

Patiënten:

algemene info operatie | toestemming operatie

Operatie-indicatie
Humeruskopfractuur links/rechts
Subcapitale humerusfractuur links/rechts

Ingreep
Philosplaat

Antibiotica prophylaxis
Zinacef 1.500 mg IV eenmalige bolus

Verslag
TOP-procedure. Position of the patient and approach. Surgery is normally performed with the patient in the beachchair position or supine position. A deltopectoral or transdeltoid approach is recommended. Reduce the head fragments and check the reduction under the image intensifier. Fix the reduction with Kirschner wires.

Note: The locking screws are not suitable for reduction since they cannot exert compression. The head fragments must be reduced before insertion of the locking screws. Option: The stability of the structure will be improved with the insertion of sutures. The insertion of sutures is especially recommended in weak bone where only short screws can be used because of the risk of penetration through settling. Draw the sutures through the appropriate holes before placing the plate against the bone. Provisionally reduce the tubercles using sutures and position the plate exactly by placing one or more thick sutures in the region of the insertion of the supraspinatus, infraspinatus, and the subcapsular tendon.

Insert the stabilization pin of the aiming device in the specially provided hole on the Philos plate. Use the screwdriver to tighten the securing screw of the aiming device. Position the plate proximally at least 8 mm distal to the upper end of the greater tubercle (rotator cuff insertion). Determine the position of the plate using a Kirschner wire. Insert the Kirschner wire into the proximal guide hole of the insertion guide below the rotator cuff so that the Kirschner wire aims at the proximal joint surface.

Note: Placing the plate at too high a level increases the risk of subacromial impingement. Placing the plate too low can prevent the optimal distribution of screws in the humerus head and make it impossible to insert screws in section "E". Centre the plate laterally against the greater tubercle, ensuring that a sufficient gap is maintained between the plate and the long biceps tendon (arterial blood supply).

Before inserting the screws, check the subsequent position of the screws using Kirschner wires. Insert one Kirschner wire in each case in sections A and E as follows: Attach a drill sleeve system, consisting of a centering sleeve for the Philos aiming device, a drill sleeve for the Philos aiming device, and a centering sleeve for the Kirschner wire, onto the aiming
device and insert a Kirschner wire 1.6 mm, 150 mm long. Check the position of both Kirschner wires under the image intensifier.

Note: If possible, the distal Kirschner wire should be positioned approx. 5 mm above the "calcar". Insert the locking screws in the proximal section depending on the respective fracture situation. Ideally, the plate should be secured with at least 4 or 6 proximal screws or more, particularly if the bone quality is poor.

Determine the length of the proximal screws and predrill screw hole
a. Using the Kirschner wire. Check the position of the Kirschner wire. The tip of the Kirschner wire should be located in the subchondral bone (5–8 mm below the joint surface). Slide the Philos direct measuring device for Kirschner wire 1.6 mm over the Kirschner wire and determine the length of the required screw. Remove the direct measuring device, the Kirschner wire, and the centering sleeve for Kirschner wire. Using a drill bit _ 2.8 mm, predrill the screw hole. Remove the drill bit and the drill sleeve.
b. Using the depth gauge. Remove the Kirschner wire and the centering sleeve for Kirschner wire. Using a drill bit 2.8 mm, predrill the screw hole through both cortices. Remove the drill bit and the drill sleeve. Determine the screw length through both cortices using the depth gauge. Deduct 10 mm from the measured reading.

Insert proximal screws. The proximal locking screws (plate holes A–E) can be inserted either
using a power tool or manually. To insert the locking screw using a power tool, fit a torque limiter to the power tool. Insert the screwdriver shaft. Pick up the locking screw and insert it through the centering sleeve for the Philos aiming device into the plate hole. To insert the screw, start the power tool slowly, increase the speed and then reduce it again before the screw is fully tightened. The torque is automatically limited and a clearly audible click signifies that the torque limit has been reached. Stop the power tool and disconnect from the screw.

Note: Do not lock the screws at full speed as this risks damaging the screw recess, which would make implant removal more

Nabehandeling